Opioid Treatment Program (OTP) in hospital inpatients

​What are a prescriber’s responsibilities when prescribing methadone or buprenorphine to opioid dependent patients in a public or private hospital?

When an opioid dependent person enters hospital it is important that the Drug and Alcohol team are actively involved in the management of the patient, regardless of whether the patient is already on an Opioid Treatment Program (OTP) or not. 

If there is no current OTP authority held by any prescriber, an application to prescribe methadone or buprenorphine on the OTP is required only if the inpatient is to be treated for a period greater than 14 days. Upon discharge of the patient the hospital prescriber and the drug & alcohol team are responsible for facilitating a seamless transfer of care to an accredited community OTP prescriber and dosing point.

If there is a current OTP authority held by a prescriber to prescribe methadone or buprenorphine for the patient upon admission, the hospital prescriber should liaise with both this prescriber and the dosing point to confirm current and last dose details (including any take-aways) and to discuss and agree on a management plan for the patient whilst in hospital.  The arrangements and management plan should be clearly documented.

If the patient has been an inpatient for more than 14 days the hospital prescriber and the current prescriber can either

1.  Agree to continue with the existing management arrangements. These arrangements should be clearly documented, or alternatively
   
2.  ​The hospital prescriber may elect to apply for the authority. The hospital prescriber applying to take over should be an accredited OTP prescriber or a staff specialist from the drug and alcohol team. This will require the permission of the current prescriber who must complete an exit from OTP for their patient. Exits from OTP can be submitted via SafeScript NSW or via submission of an Exit from Methadone, Buprenorphine or Other Opioid Agonist Therapy (OAT) Treatment under the NSW Opioid Treatment Program.  If unable to access SafeScript NSW then OTP Application and exit forms can be submitted to the Pharmaceutical ​Services Unit as soon as possible. Prior to discharge of the patient the hospital prescriber and the drug & alcohol team are responsible for facilitating a seamless transfer of care to an accredited OTP prescriber and dosing point in ​the community.   

Please note there is NO requirement in any of the above circumstances for a community prescriber to supply a prescription to the hospital.  A direction on an inpatient chart satisfies the legal requirements for administration of methadone or buprenorphine in a hospital.